CMS Proposes Timeline for Providers to Return Overpayments

The Centers for Medicare and Medicaid Services (CMS) yesterday proposed that providers and suppliers must report and return self-identified overpayments either within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due—whichever is later.

The announcement is 1 in a series of steps Medicare is taking to protect taxpayer dollars, including efforts to prevent overpayments from occurring. These efforts include allowing private auditors working on behalf of Medicare to catch wasteful spending before it happens by expanding the use of Recovery Audit Contractors, testing changes to outdated hospital billing systems to help prevent overbilling, and changing processes for approving payments for medical equipment with high error rates.

A Medicare overpayment refers to any funds that a person receives or retains under Medicare to which the person is not entitled. Examples of overpayments in Medicare include the following:

duplicate submission of the same service or claim

payment to the incorrect payee

payment for excluded or medically unnecessary services

payment for non-covered services

Any failure to report and return the overpayment within the applicable time frame could be a violation of the False Claims Act. Providers also could be subject to civil monetary penalties or excluded from participating in federal health care programs for failure to report and return an overpayment.

Before the Affordable Care Act (ACA) providers did not face an explicit deadline for returning overpayments. CMS has received approximately $5 million in overpayment refunds under ACA. Contractors also have received a substantial number of overpayment refunds.

APTA is analyzing CMS' proposal and will post a summary on www.apta.org shortly.

Also yesterday, the Obama Administration announced that the Health Care Fraud and Abuse Control Program had recovered $4.1 billion in Fiscal Year 2011 from anti-fraud efforts, while the Department of Justice opened 1,110 new criminal health care fraud investigations involving 2,561 potential defendants.